[Subtotal reconstructive laryngectomy: author's experience].

The authors conclude 18 year's experience with reconstructive laryngectomy by adopting two surgical techniques for intrinsic laryngeal tumors. The first, where one or both of the arytenoids are conserved, can be applied in cases of supraglottic neoplasms extending to the glottis as well as in glottic cancers where a simple cordectomy is not feasible. In both cases this technique is indicated when at least one arytenoid is respected. The second technique involves removal of both arytenoids and is used in cases of intrinsic supraglottic or glottic tumors extended to both arytenoids. The anatomic-pathological criteria supporting these techniques are: 1) the presence of a fibrous ligament anterior to the arytenoid vocal process. This makes possible proper exeresis within healthy tissue (as can be done in supraglottic surgery due to the anatomic characteristics at the anterior commissure level); 2) neoplastic infiltration of the cricoid cartilage takes place exceptionally in supraglottic and glottic neoplasms; in such cases neoplastic manifestation can be radiographically identified. Generally removal of the soft tissues and of the perichondrium within the cricoid area grants conservative surgery the same oncological radicality as that of total laryngectomy. Insights into restoration of laryngeal function when employing the arytenoid-preserving technique are as follows: 1) conservation of the recurrent nerve(s) 2) pulling the base of the tongue back and downward; close to the crico-arytenoid structure can be achieved by crico-hyoid-pexy. In the technique involving removal of the arytenoid: 1) reconstruction of two pseudo-arytenoids 2) the base of the tongue has to be brought close to the edge of the cricoid cartilage possibly by crico-hyoid-pexy. A total of 21 patients have undergone surgery with these techniques since 1984 and to date no neoplastic recurrences have been observed. Those who underwent surgery where the arytenoids were preserved (16 cases) showed laryngeal functional recovery times similar to those for supraglottic surgery. The recovery times were longer for those undergoing bilateral arytenoidectomy (5) and this was especially so for swallowing.